19 April 2007

OK, that's pretty impressive. On any given night in our ED, being >400 on the blood alcohol scale (or >.400, depending on the units you prefer) will probably win you the gold star for the evening. I've seen someone walking and talking at >500. He was acting more sober at that level than I would have at 100, and in fact I might not have noticed that he was drunk at all, if it were not for the slightly slurred speech and distinct odor of ketones. I've seen 800 as the highest level I have personally witnessed, and that was a chronic inebriate who managed to get himself well and truly comatose (and intubated). Some of my partners report having seen levels over 1000, which stretches credulity, but I believe it.

And just for reference, legally intoxicated is 80 (or 0.08). Yeah, 400 is pretty high.

12 comments:

And not a day passes that we don't see one or two of these people. There was an article in the San Francisco post about the revolving cast of drunks they see in the hospitals there which costs the hospitals and taxpayers millions every year.

Personally, I think it made no difference. My experience is biased, since to come to the ER you need to be injured in a DUI, and that may select out some more low level drunks. BUT, my experience is that the folks injured in DUIs tend to have alcohol levels quite high. I actually can't recall the last DUI patient whose BA was between 80 and 100. 150 and up is more typical.

Which might actually argue that it is a pointless change -- that if the folks in that 80-100 range aren't getting in accidents in droves, there is less of a safety argument for prohibiting it.

But really, it's so personally variable. I am sure that I can't drive safely at 50. I know many folks who are dead sober and starting to shake and withdraw at 200. So a fixed cut off is necessary for pragmatic reasons but I suspect is by the nature of the thing arbitrary and meaningless.

A hard number somewhat below what is truly dangerously impaired is probably the only viable option for lawmakers. Dropping it from 100 to 80 when a reasonably experienced ER doctor says people are almost always above 150 may seem meaningless, but maybe police have found out that when people are above 110 they are noticably causing traffic problems.

You'd have to do the study, but I imagine, as Shadowfax implied, that it's a normal distribution: that car accidents bad enough to cause injury start at about 150. Let's assume that's maybe 2 SDs on the low side, with 500-600 being 2 SDs on the high side. So to catch 90%-95% of the population who's out there driving impaired, lower that by another SD and you've got a really good rule of thumb.

I'm making all sorts of assumptions due to ignorance (I understand math, statistics and normal distributions, but I have no experience on drunk driving, injuries, traffic, etc), but the reasoning is perfectly sound.

What I also think is true, however, is that state and federal legislatures almost never make their decisions for sound statistical or scientific reasons, so the move to 80 from 100 is probably 100% political so they can all say, "I'm tough on drunk driving."

[What I also think is true, however, is that state and federal legislatures almost never make their decisions for sound statistical or scientific reasons, so the move to 80 from 100 is probably 100% political so they can all say, "I'm tough on drunk driving."]

Ug. So true. The same goes for drug sentencing. Or public safety regulations. This is why the authoritarian left worries me. Not because what they do is so bad (IMHO) but because it can never ever be reconsidered.

We recently had one of our alcohol-addicted patients test out at .45 in the hospital the other day. What is sad is that these people have such high tolerances that they MUST drink constantly, all day long, in order to stay out of the DT's. I read some sobering (no pun intended) statistics: even if these people ARE very closely medically detoxed, the stats are high that they will actually die from the detoxing, something like 30 percent.

We recently had a patient in my ICU who presented with a level of .746. The scary thing is that this was his second time hitting the 700s--he did it last fall, was with us for a while, got trached, the whole deal. When he finally got out, he went back to the streets(homeless), and did it again within 2.5 months. He stayed in our ICU for over 2 months this time, finally left last week or so.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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